Thursday, October 24, 2013

My own case history with a 1998 hip fracture: do the privileged "get in front of the line" for health care?

On Tuesday, January 6, 1998, I was at my mainframe computer terminal at work at ReliaStar in downtown Minneapolis, when the  connection hung.  I walked across the street to a Tom Thumb, in a Skyway extension of the Churchill Apartments in which I lived, to get coffee.  People had tracked in snow into the corridors and of course they were wet, as was the store.  As I made a sharp left turn to walk into the store, I slipped and fell, and sustained a severe acetabular fracture of the left hip.  Had the normal friction mats been put down, I would not have slipped, but somehow the store had forgotten to do so.
  
First, I did litigate, and did get a pre-trial settlement finally, from which ReliaStar’s insurance company could subrogate.  But the real story is both with the care I got and how the insurance policy worked, and it does bear on today’s debate on Obamacare, as well as broader ethical and social problems.
  
I was taken to an emergency room at Methodist Hospital all the way in St. Louis Park, eight miles away, where I was xrayed, before being moved to Riverside, part of the University of Minnesota system, near downtown Minneapolis.  I was able to get a major MRI or cat scan that day, and a top flight surgeon was called in.  I was moved across the river to the main campus hospital in the University of Minnesota system.  On Thursday, January 8, I did have a six-hour operation to set the pelvis fracture with a new titanium implant rod, which is still in place.  It does not create issues at airports.  There was no hip replacement; it was the hip socket that was cracked, not the femur head, which is more common.
  
Recovery seemed slow at first.  One week later, I was moved back to Riverside, but into a different building for “Acute Care Rehab”, with an environment that seemed like a nursing home.  But I did have two physical therapy sessions a day, in a large room that had a spectacular view of the Mississippi River – as did my own room, where I had visitors and conversations with my attorney.  At one point, I saw an amputee take his first steps with an artificial limb.

I reached an inflection point, and then made progress on crutches very rapidly, being able to walk on crutches to the cafeteria myself (about 1000 feet) after five days there.  There was one scare with foot swelling, which happens when one cannot put weight on a limb.  I was discharged after one week, and managed to take care of myself at home, with some friends bringing groceries.  I got back to week on Tuesday, January 27, after just three weeks. 

I sometimes took cabs to the movies, like in Uptown, and found what it was like to sit in a handicapped seat.  At the Gay 90’s, I got an elevator ride to the dance floor.  By March 1, I was able to walk short distances without crutches.  By March 23, I was able to ditch crutches completely for an evening at the Orpheus Theater on Hennepin for a Minnesota AIDS Project Benefit for the Academy Awards (now it’s held in February).   This was actually a great time in my life.

The health insurance company was Health Net, which was supposed to be non-profit, rather like a BCBS plan.  Still, the company tried to get out of paying much of the claim, saying I had been sent to a non-network hospital.  Pressure from my attorney got the claim settled, they paid.  That was important, because the “list price” for the room stay in each hospital went down about 70% once Health Net accepted responsibility.   The stay at the rehab listed at $4400 for seven days, but once Health Net acknowledged a contractural responsibility, the list price dropped to about $1300 for the same period, a huge discount.  Also, it appeared that the surgery itself and the titanium device never appeared on the bill.  I was told that the device was offered free because I was one of the first patients ever to receive the device from the company.  It did work properly.  I did recover 95% function in the hip.  Today, 15 years later, there is sometimes some arthritic pain which is controlled by medication. A need for a hip replacement is unlikely.
  
I also got full pay during the three weeks out, because ReliaStar had short-term disability at 100%.  It also offered long-term disability for very low premiums.  That is significant because Social Security also pays for a long term disability plan – a small part of your FICA funds this. It is “mandatory” and nobody considers it politically controversial (not even Ted Cruz).
  
What’s the moral of this story?  I had good insurance, but I had to fight to get it to work. I won the fight because I had good “connections” through an influential employer with deep pockets and the ability to exert legal and political pressure.  I also got state of the art treatment.  Had this accident happened in Britain or Canada, I wonder if I would have lay in traction much longer, risking pneumonia, and out of work much longer, and with a much less successful result. 
  
We do indeed have a system where the people with money or connections can get ahead in line, and avoid the risks that others must take.  That is indeed a major cause of social instability and the brazenness of some crime. 
  
We have the ability to deliver state-of-the-art care, but not the means or money to do it for everyone.
  
We’re seeing that medicine can offer much more in the area of lifesaving treatments than were possible when I was growing up.  For example, ABC anchor Robin Roberts received a bone marrow transplant, with great media coverage and support, for an early malignancy.  This could not have been done until recently and could not be done with a lot of support from others.  The availability of new medical treatment is a factor in eldercare.  My mother received open-heart coronary bypass surgery at age 85 in 1999, and I was surprised that it could be offered at all at that age.  Fortunately, I did not have to come back from Minneapolis, but for a while I was concerned that my flexibility could have become a bargaining chip in her eligibility.
  
Getting beyond the problems with the website, Obamacare does seem to be resulting in more disruption of full-time employment markets than had been expected, and higher premiums than expected for individual insurance.  Self-only premiums, paid with pretax dollars, in employer groups have always been cheap compared to what individuals can buy even under Obamacare, and were also cheap compared to family coverage.  But I don’t see any way out of the anti-selection problem in the individual market (with pre-existing conditions) other than mandatory insurance (subsidized for the poor), which sets up examples in other areas of society.    
   

Does this add to the “entitlement” mentality, as conservatives claim?  No, because you have to pay a premium, just as you have to pay a FICA tax for future Social Security.  I do think we have to look at countries with private-public plans that really work (like Switzerland and Germany) for guidance.  I think we need to look at portability, and, as with social security, give people more “ownership” over their own health care funds.   

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